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General NPI Number Information
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NPI Number | 1073169553
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Entity Type | Individual
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Provider Name | KAYLA PACIC MA
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Gender | Female
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 23100 JEFFERSON AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2756
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Country | US
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Telephone | 586-335-2006
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Fax |
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Provider Business Mailing Address
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Address Line | 4341 SUMMERLANE AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9507
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Country | US
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Telephone | 616-558-6837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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